Provider Demographics
NPI:1740235738
Name:DE LUCA, LAURIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:J
Last Name:DE LUCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25595
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5595
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:727-828-0723
Practice Address - Street 1:7171 N DALE MABRY HWY
Practice Address - Street 2:STE 404
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2665
Practice Address - Country:US
Practice Address - Phone:813-932-1510
Practice Address - Fax:813-238-4378
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94019207P00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29406OtherBCBS OF FLORIDA
FLP01037262OtherRAILROAD MEDICARE ATTACHED TO GRP# DQ1103
FL273731100Medicaid
P00607594Medicare PIN
FLP01037262OtherRAILROAD MEDICARE ATTACHED TO GRP# DQ1103
FL29406ZMedicare PIN
FLP00337264Medicare PIN
FL29406YMedicare PIN
FL29406OtherBCBS OF FLORIDA
FL29406XMedicare PIN